| NPI | 1831546266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: UT 9668264-6004) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: UT 9668264-6009) |
| Enumeration Date | 2016-05-16 |
| Last Update Date | 2019-05-16 |